The Public Health Foundation of India had been working on government programmes since 2010.

The Ministry of Home Affairs has barred the Public Health Foundation of India from receiving foreign funding by revoking its registration under the Foreign Contributions (Regulation) Act. The ministry cited the organisation’s lobbying against tobacco use as one of the reasons for the move. However, as the foundation’s officials have pointed out, it has been working with the Ministry of Health and Family Welfare on anti-tobacco programmes since 2010.

The Public Health Foundation of India is a public-private initiative established to provide technical support to the health ministry on a range of issues concerning public health, including tobacco control. The foundation has worked on several research projects and organised training workshops for health workers on how to counter tobacco consumption. It took on many of these initiatives at the ministry’s request.

In July 2015, experts from the foundation were asked to present evidence before a Parliamentary Committee on Subordinate Legislation that was reviewing pictorial health warnings on tobacco packets.

Health activists working on tobacco control have said that the home ministry’s position is appalling. “We have to interact with the government on any issue related to social development, not just tobacco control,” said Sanjay Seth from Voice of Tobacco Victims, a campaign that is putting tobacco victims at the forefront of the tobacco control movement in India. “How can they officially raise [anti-tobacco lobbying] as an issue?”

Other reasons cited by the home ministry’s for cancelling the foundation’s licence include alleged violations in the use of funds for HIV/AIDS projects, remittances to foreign countries from its Foreign Contribution Regulation Act account and failure to declare all its bank accounts to the government.

In October, the government cancelled the Foreign Contribution Regulation Act licence of the Institute of Public Health in Bengaluru and Voluntary Health Association of Assam, both which have done considerable work on tobacco control. However, the reasons for their licences being cancelled were not specifically stated.

Tobacco is one of the leading causes of cancer and non-communicable diseases around the world. Every year 9.8 lakh people in India die of a tobacco-caused disease. Research done by the Public Health Foundation of India under the directives of the government estimates that the health costs attributable to tobacco use in the year 2011 for people between the ages of 35 and 69 amounted to Rs 1,04,500 crores.

“Tobacco control activity is not a criminal activity,” said Dr Pankaj Chaturvedi, cancer surgeon at Tata Memorial Hospital. “We are furthering the cause of government of India and augmenting the National Tobacco Control Programme.”

Health ministry not consulted

The home ministry does not seem to have consulted the health ministry before barring the foundation’s foreign funding. Three health ministry officials told Scroll.in that they had not been informed about the order and only learned about it only from newspaper articles. They said they were surprised by the home ministry’s decision.

The health ministry runs the National Tobacco Control Programme to enforce the Cigarettes and Other Tobacco Products Act and spread awareness about the harms of tobacco. The government has allocated a budget of about Rs 40 lakhs per state and Rs 47 lakhs for each of the 400 districts under the programme this financial year.

“Our stance is very clear on tobacco control,” said Dr Arun Panda, additional secretary with the health ministry, who said that the ministry will continue its work to curb tobacco consumption.

Only last year, the government made encouraging moves to curb tobacco use in the country when it mandated that pictorial warnings must cover 85% of boxes containing tobacco products, as against 40% previously. This means that after Nepal and Vanuatu, India has some of the largest pictorial warnings on tobacco packets in the world.

In November, India hosted the seventh Conference of Parties of the Framework Convention on Tobacco Control, which takes decisions necessary to promote effective tobacco control implementation. The convention encourages countries to take measures such as outlawing smoking in public and restricting advertising and sponsorship of tobacco products. Health Minister JP Nadda made a commitment at the inaugural speech of the conference to continue efforts to regulate the use of tobacco products in the country.

However, even as the conference was underway, advertisements appeared on hoarding and even on the backs of autorickshaws alleging that anti-tobacco activists has “hidden agendas” that hurt the interests of tobacco farmers and paan wallahs.

The action against the Public Health Foundation of India comes at a time when anti-tobacco movements in India are showing some signs of success. The National Family Health Survey showed that the percentage of men and women who use tobacco has dropped in the past decade. In 2005-’06, 57% of men used tobacco, which has dipped to 44.5% in 2015-’16. In 2005-’06, 10.8% of women used tobacco which has dipped to 6.8% in 2015-’16.

Most organisations in India that work on tobacco control rely on foreign funds with much of their money coming from the Bloomberg Initiative to Reduce Tobacco Use, which funds anti-tobacco programmes around the world. The home ministry’s crackdown on the Public Health Foundation of India has alarmed many activists working with these organisation. Seth of Voice of Tobacco Victims said that the home ministry’s move blatantly favours the tobacco industry. A faculty member of the Institute of Public Health alleged that might have been targeted because they were working effectively against tobacco control.

Claimed cancer surgeon Chaturvedi: “This move is conspiracy of the tobacco lobby to malign non-governmental organisations working on tobacco control.”

Adopting three simple habits can help maximise the benefits of existing sanitation infrastructure.

India’s sanitation problem is well documented – the country was recently declared as having the highest number of people living without basic sanitation facilities. Sanitation encompasses all conditions relating to public health - especially sewage disposal and access to clean drinking water. Due to associated losses in productivity caused by sickness, increased healthcare costs and increased mortality, India recorded a loss of 5.2% of its GDP to poor sanitation in 2015. As tremendous as the economic losses are, the on-ground, human consequences of poor sanitation are grim - about one in 10 deaths, according to the World Bank.

Poor sanitation contributes to about 10% of the world’s disease burden and is linked to even those diseases that may not present any correlation at first. For example, while lack of nutrition is a direct cause of anaemia, poor sanitation can contribute to the problem by causing intestinal diseases which prevent people from absorbing nutrition from their food. In fact, a study found a correlation between improved sanitation and reduced prevalence of anaemia in 14 Indian states. Diarrhoeal diseases, the most well-known consequence of poor sanitation, are the third largest cause of child mortality in India. They are also linked to undernutrition and stunting in children - 38% of Indian children exhibit stunted growth. Improved sanitation can also help reduce prevalence of neglected tropical diseases (NTDs). Though not a cause of high mortality rate, NTDs impair physical and cognitive development, contribute to mother and child illness and death and affect overall productivity. NTDs caused by parasitic worms - such as hookworms, whipworms etc. - infect millions every year and spread through open defecation. Improving toilet access and access to clean drinking water can significantly boost disease control programmes for diarrhoea, NTDs and other correlated conditions.

Unfortunately, with about 732 million people who have no access to toilets, India currently accounts for more than half of the world population that defecates in the open. India also accounts for the largest rural population living without access to clean water. Only 16% of India’s rural population is currently served by piped water.

However, there is cause for optimism. In the three years of Swachh Bharat Abhiyan, the country’s sanitation coverage has risen from 39% to 65% and eight states and Union Territories have been declared open defecation free. But lasting change cannot be ensured by the proliferation of sanitation infrastructure alone. Ensuring the usage of toilets is as important as building them, more so due to the cultural preference for open defecation in rural India.

According to the World Bank, hygiene promotion is essential to realise the potential of infrastructure investments in sanitation. Behavioural intervention is most successful when it targets few behaviours with the most potential for impact. An area of public health where behavioural training has made an impact is WASH - water, sanitation and hygiene - a key issue of UN Sustainable Development Goal 6. Compliance to WASH practices has the potential to reduce illness and death, poverty and improve overall socio-economic development. The UN has even marked observance days for each - World Water Day for water (22 March), World Toilet Day for sanitation (19 November) and Global Handwashing Day for hygiene (15 October).

At its simplest, the benefits of WASH can be availed through three simple habits that safeguard against disease - washing hands before eating, drinking clean water and using a clean toilet. Handwashing and use of toilets are some of the most important behavioural interventions that keep diarrhoeal diseases from spreading, while clean drinking water is essential to prevent water-borne diseases and adverse health effects of toxic contaminants. In India, Hindustan Unilever Limited launched the Swachh Aadat Swachh Bharat initiative, a WASH behaviour change programme, to complement the Swachh Bharat Abhiyan. Through its on-ground behaviour change model, SASB seeks to promote the three basic WASH habits to create long-lasting personal hygiene compliance among the populations it serves.

This touching film made as a part of SASB’s awareness campaign shows how lack of knowledge of basic hygiene practices means children miss out on developmental milestones due to preventable diseases.

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SASB created the Swachhata curriculum, a textbook to encourage adoption of personal hygiene among school going children. It makes use of conceptual learning to teach primary school students about cleanliness, germs and clean habits in an engaging manner. Swachh Basti is an extensive urban outreach programme for sensitising urban slum residents about WASH habits through demos, skits and etc. in partnership with key local stakeholders such as doctors, anganwadi workers and support groups. In Ghatkopar, Mumbai, HUL built the first-of-its-kind Suvidha Centre - an urban water, hygiene and sanitation community centre. It provides toilets, handwashing and shower facilities, safe drinking water and state-of-the-art laundry operations at an affordable cost to about 1,500 residents of the area.

HUL’s factory workers also act as Swachhata Doots, or messengers of change who teach the three habits of WASH in their own villages. This mobile-led rural behaviour change communication model also provides a volunteering opportunity to those who are busy but wish to make a difference. A toolkit especially designed for this purpose helps volunteers approach, explain and teach people in their immediate vicinity - their drivers, cooks, domestic helps etc. - about the three simple habits for better hygiene. This helps cast the net of awareness wider as regular interaction is conducive to habit formation. To learn more about their volunteering programme, click here. To learn more about the Swachh Aadat Swachh Bharat initiative, click here.

This article was produced by the Scroll marketing team on behalf of Hindustan Unilever and not by the Scroll editorial team.